Treatment of Styes (Hordeolum)
The best way to treat a stye is with warm compresses for 10-15 minutes, 3-4 times daily, combined with eyelid hygiene and gentle massage as first-line therapy, followed by topical antibiotics if needed. 1
Step-wise Treatment Approach
First-line Treatment
- Warm compresses: Apply for 10-15 minutes, 3-4 times daily
- This helps liquefy the blocked secretions and promotes drainage
- Use clean, warm (not hot) washcloth or commercial eye compress
- Eyelid hygiene: Clean eyelids with mild soap or commercial eyelid cleanser
- Gentle massage: After warm compress, gently massage the affected area to encourage drainage
Second-line Treatment
- Topical antibiotics: Add if signs of infection or risk of secondary infection
- Bacitracin or erythromycin ointment applied directly to the affected eyelid
- Erythromycin ointment can be applied approximately 1 cm in length up to six times daily, depending on severity 1
- Treatment typically lasts a few weeks, guided by symptom response
Third-line Treatment
- Combination antibiotic/steroid topical treatment for moderate to severe cases 1
- Note: Topical steroids should be used short-term only unless the patient has autoimmune disease or moderate to severe dry eye disease
Fourth-line Treatment
- Intralesional steroid injection or incision and curettage for persistent (>2 months) or large chalazia 1
Important Considerations
Differentiating Types of Styes
- External stye (external hordeolum): Infection of eyelash follicle or gland of Zeis
- Internal stye (internal hordeolum): Infection of meibomian gland
- Chalazion: Chronic, non-infectious inflammation of meibomian gland
Evidence Quality
The American Academy of Ophthalmology provides clear guidelines for stye management 1. Interestingly, a Cochrane review found no high-quality randomized controlled trials specifically for internal hordeolum treatment, highlighting a gap in research evidence 2.
Alternative Treatments
Some research suggests ear-apex blood-letting may be effective for external styes, with one study showing superior pain relief and faster resolution compared to topical antibiotics 3, 4. However, this approach is not mentioned in mainstream ophthalmology guidelines and requires further research before widespread recommendation.
Prevention of Recurrence
- Practice good eyelid hygiene consistently
- Remove eye makeup completely before sleeping 1
- Treat underlying conditions that may contribute to styes:
- Seborrheic dermatitis
- Rosacea
- Eczema
- Thyroid dysfunction 1
- Discontinue contact lens wear until symptoms completely resolve
When to Refer to a Specialist
Refer to an ophthalmologist if:
- Visual changes occur
- Corneal involvement is suspected
- Severe eyelid swelling unresponsive to initial treatment
- Suspected malignancy
- Cicatricial changes in the conjunctiva 1
- Marked asymmetry between eyes
- Unifocal recurrent chalazia
- Loss of normal eyelid margin anatomy
- Focal lash loss (madarosis) 1
Common Pitfalls to Avoid
- Don't squeeze or pop a stye - this can spread infection
- Avoid using eye makeup during active infection
- Don't use contact lenses until the stye has completely resolved
- Don't overuse topical antibiotics without clear indication
- Don't ignore underlying conditions that may predispose to recurrent styes